LAS VEGAS – The electronic health record mandate for physicians who participate in Medicare or Medicaid may have the unintended consequence of being the cudgel that drives many remaining private practice physicians out of business, Dr. Steve G. Peters said at the annual meeting of the National Association for Medical Direction of Respiratory Care.
"No one will admit it, but there is de facto pressure [from the electronic health record mandate] that there won’t be private practice in the foreseeable future," said Dr. Peters, a critical care physician and professor of medicine at the Mayo Clinic in Rochester, Minn. "Everyone will need to report measures on hundreds of patients," and to afford to do that they will likely have to become part of an organization, he said.
Dr. Steve G. Peters
The challenge of meeting the electronic health record (EHR) reporting requirements will ratchet up over the next several years as the increasingly demanding stages of the Health Information Technology for Economic and Clinical Health (HITECH) Act begin to kick in.
In stage 1, which started this year, physicians using a certified EHR and participating in Medicare or Medicaid must report to the Center for Medicare and Medicaid Services (CMS) three core measures for each patient – height, weight, and blood pressure – as well as three additional measures from a list of 38 options. During the next few years, the program will expand into stages 2 and 3 with additional data reporting requirements.
"It sounds easy, but it’s not," Dr. Peters said. The way to program an EHR to report these various measures "differs from measure to measure, and when you get into it, it’s very complicated. We’re [currently] working this through at Mayo. We have a full EHR at Mayo, but extracting out the data for reporting is proving to be difficult. We have 85% of it, but the gap, the final 15%, is hard."
As an example, he cited the challenge of automatically reporting to the CMS what happens with patients who have a body mass index of 30 kg/m2 or greater. "You need to record and report an action plan of what you’ll do about this, and if not, why not. You need to somehow capture it in a file that can be reported out of your computer why you did not achieve the measure."
The EHR information demands required by the HITECH law are "overwhelming," commented Dr. Alan H. Morris, a pulmonologist and professor of medicine at the University of Utah in Salt Lake City. "It’s a huge operation. What if a physician does not have the infrastructure of the Mayo Clinic?"
Those consequences were exemplified by an attendee at the meeting, Dr. Theodore S. Ingrassia III, a pulmonologist in private practice who maintains an office cooperatively with two other pulmonologists in Rockford, Ill.
"The EHR is a disaster for us, because the cost of the hardware and software is just a fraction of the total cost. There is the expensive cost of getting an IT person to help maintain it and keep it current with all the demands. It may drive us out" of private practice, Dr. Ingrassia said during the session.
"Many predicted that the [$44,000 ] incentive from CMS will not buy much EHR for a big, complex practice. It is a sobering phenomenon," Dr. Peters said.
"The EHR is supposed to be a tool to help physicians organize their care, but it is being turned into something like an enemy," said Dr. Dennis E. Doherty, a pulmonologist and critical care medicine physician and professor of medicine at the University of Kentucky in Lexington.
The three major hospitals in Rockford recognized the information technology and cost challenges that the new EHR requirements pose, and have offered to provide Dr. Ingrassia with the IT support he needs to meet CMS reporting demands if he gives up his private practice and joins their staff. It’s a tempting proposal, he said, but he remains very reluctant to abandon the private practice he built over the past 20 years, he said in an interview. For the time being, his strategy rests on deferring the EHR with the hope that the financial penalties scheduled to start in 2015 for noncompliance may get delayed or that some other option emerges.
Dr. Peters, Dr. Morris, Dr. Ingrassia, and Dr. Doherty had no disclosures relevant to this topic.